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Applications for state of Illinois

If you have any questions, please call (818) 654-4548  
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  • Permanent - Individual & Family Health Plans
UniCare Health Plans - Online Application
UniCare Health Plans - Printable Application
Sound Health Insurance - Online Application NEW
 
Aetna Health Plans Online Application
Aetna Health Plans - Printable Application
Aetna Health Plans - Order the Application
 
Golden Rule   - Online Application
 
 
Assurant Health Individual & Family Health Plans - Online Application
Assurant Health Short Term Health Plans - Online Application
Assurant Health Student Health Plans - Online Application
 
Celtic Health Insurance online application
 
 
 
 
  • Temporary Individual & Family Health Plans
 
UniCare Health Plans - Online Application
UniCare Health Plans - Printable Application
 
 
Assurant Health Short Term Health Plans - Online Application
 
 
 
 
  • MediCare Plans
 
 
  • Medicare Drug Benefits part D
UniCare Medicare Supplement - Printable Application
UniCare MedicareRx Rewards - Order the Application
 
blue cross Health Net Orange Rx - Printable
 

Cigna Rx

 

blue cross Cigna Rx Application   - Printable 
blue cross Cigna Rx Application   - Online Application
 
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  • Dental Plans
 
Unicare Detnal - Printable Application
 
 
 
ALL APPLICATION MAIL TO:

Oleg Skurskiy
18375 Ventura Blvd. # 226
Tarzana , CA 91356

You also can fax complete application to Fax: (818) 776-9865

If you have any questions, please call (818) 987-5000

 

 

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Additional Cities in the State of Illinois : Illinois Health Insurance
- 62950 - -89.54436 - 37.74374 - Jacob - IL - - 618 - CST - 62985 - -88.76246 - 37.46303 - Simpson - IL - - 618 - CST - 62036 - -90.56020 - 38.89614 - Golden Eagle - IL - - 618 - CST - 60620 - -87.65425 - 41.74112 - Chicago - IL - - 773 - CST - 62565 - -88.80462 - 39.40487 - Shelbyville - IL - - 217 - CST - 62766 - -89.64000 - 39.80000 - Springfield - IL - - 217 - CST - 60030 - -88.03779 - 42.34848 - Grayslake - IL - - 847 - CST - 61363 - -89.18000 - 41.26000 - Standard - IL - - 815 - CST - 60967 - -87.59000 - 40.61000 - Stockland - IL - - 815 - CST - 62932 - -89.23357 - 37.91551 - Elkville - IL - - 618 - CST - 60610 - -87.63357 - 41.90329 - Chicago - IL - - 312 - CST - 60604 - -87.63300 - 41.87845 - Chicago - IL - - 312 - CST - 62761 - -89.64000 - 39.80000 - Springfield - IL - - 217 - CST - 61455 - -90.67867 - 40.46167 - Macomb - IL - - 309 - CST - 61742 - -89.27000 - 40.63000 - Goodfield - IL - - 309 - CST - 60463 - -87.79270 - 41.66210 - Palos Heights - IL - - 708 - CST - 60927 - -87.92024 - 40.93944 - Clifton - IL - - 815 - CST - 62070 - -90.71498 - 39.28772 - Mozier - IL - - 618 - CST - 60637 - -87.60510 - 41.78131 - Chicago - IL - - 773 - CST - 60449 - -87.77484 - 41.41913 - Monee - IL - - 708 - CST - 61638 - -89.61000 - 40.80000 - Peoria - IL - - 309 - CST - 62027 - -90.53287 - 39.28359 - Eldred - IL - - 217 - CST - 61913 - -88.44940 - 39.80440 - Atwood - IL - - 217 - CST - 62460 - -87.67363 - 38.61249 - Saint Francisville - IL - - 618 - CST - 62841 - -89.03000 - 37.80000 - Freeman Spur - IL - - 618 - CST - 62864 - -88.91053 - 38.31701 - Mount Vernon - IL - - 618 - CST - 61545 - -89.37040 - 40.87108 - Lowpoint - IL - - 309 - CST - 61458 - -90.20084 - 40.78486 - Maquon - IL - - 309 - CST - 62553 - -89.08364 - 39.28841 - Oconee - IL - - 217 - CST - 62704 - -89.68107 - 39.78032 - Springfield - IL - - 217 - CST - 61063 - -89.34723 - 42.30511 - Pecatonica - IL - - 815 - CST - 61285 - -90.08444 - 41.98163 - Thomson - IL - - 815 - CST - 62869 - -88.32434 - 37.97730 - Norris City - IL - - 618 - CST - 62031 - -90.52974 - 39.10861 - Fieldon - IL - - 618 - CST - 62957 - -89.45312 - 37.30198 - Mc Clure - IL - - 618 - CST - 60546 - -87.82136 - 41.83737 - Riverside - IL - - 708 - CST - 61864 - -88.15951 - 40.00516 - Philo - IL - - 217 - CST - 61450 - -90.96870 - 40.58460 - La Harpe - IL - - 217 - CST - 60408 - -88.22312 - 41.26574 - Braidwood - IL - - 815 - CST - 61652 - -89.60000 - 40.69000 - Peoria - IL - - 309 - CST - 62656 - -89.36838 - 40.14508 - Lincoln - IL - - 217 - CST - 60670 - -87.65000 - 41.85000 - Chicago - IL - - 312 - CST - 60643 - -87.65940 - 41.69320 - Chicago - IL - - 773 - CST - 61111 - -89.03352 - 42.32952 - Loves Park - IL - - 815 - CST - 61276 - -90.58000 - 41.31000 - Preemption - IL - - 309 - CST - 60530 - -88.97139 - 41.78642 - Lee - IL - - 815 - CST - 61311 - -88.76604 - 41.05512 - Ancona - IL - - 815 - CST - 62930 - -88.44338 - 37.81389 - Eldorado - IL - - 618 - CST - 60187 - -88.10763 - 41.85659 - Wheaton - IL - - 630 - CST - 61841 - -87.83646 - 40.03733 - Fairmount - IL - - 217 - CST - 61949 - -87.86000 - 39.65000 - Redmon - IL - - 217 - CST - 60465 - -87.82628 - 41.70039 - Palos Hills - IL - - 708 - CST - 61791 - -88.95000 - 40.48000 - Bloomington - IL - - 309 - CST - 62351 - -91.28992 - 40.08566 - Mendon - IL - - 217 - CST - 61077 - -89.36000 - 42.24000 - Seward - IL - - 815 - CST - 60171 - -87.83871 - 41.92789 - River Grove - IL - - 708 - CST - 62458 - -88.85518 - 39.03154 - Saint Elmo - IL - - 618 - CST - 61643 - -89.56000 - 40.72000 - Peoria - IL - - 309 - CST - 61550 - -89.46040 - 40.61480 - Morton - IL - - 309 - CST - 61736 - -88.87081 - 40.38086 - Downs - IL - - 309 - CST - 61375 - -89.24833 - 41.03272 - Varna - IL - - 309 - CST - 62831 - -89.20419 - 38.25264 - Du Bois - IL - - 618 - CST - 62828 - -88.63631 - 38.19748 - Dahlgren - IL - - 618 - CST - 61350 - -88.84159 - 41.35262 - Ottawa - IL - - 815 - CST - 61426 - -89.71000 - 41.12000 - Castleton - IL - - 309 - CST - 60694 - -87.65000 - 41.85000 - Chicago - IL - - 312 - CST - 61336 - -89.22701 - 41.11637 - Magnolia - IL - - 815 - CST - 61278 - -90.35000 - 41.58000 - Rapids City - IL - - 309 - CST - 62450 - -88.08094 - 38.73339 - Olney - IL - - 618 - CST - 62706 - -89.64000 - 39.80000 - Springfield - IL - - 217 - CST - 61726 - -88.72185 - 40.74463 - Chenoa - IL - - 815 - CST - 61016 - -88.96192 - 42.22056 - Cherry Valley - IL - - 815 - CST - 62675 - -89.84787 - 40.01153 - Petersburg - IL - - 217 - CST - 62263 - -89.38406 - 38.33521 - Nashville - IL - - 618 - CST - 60208 - -87.68000 - 42.06000 - Evanston - IL - - 847 - CST - 61438 - -90.63243 - 40.57489 - Good Hope - IL - - 309 - CST - 62094 - -89.34143 - 39.24692 - Witt - IL - - 217 - CST - 62931 - -88.28674 - 37.46649 - Elizabethtown - IL - - 618 - CST - 60544 - -88.19939 - 41.60088 - Plainfield - IL - - 815 - CST - 60699 - -87.65000 - 41.85000 - Chicago - IL - - 312 - CST - 60151 - -88.59985 - 41.92322 - Maple Park - IL - - 815 - CST - 60305 - -87.81590 - 41.89506 - River Forest - IL - - 708 - CST - 62836 - -88.85044 - 38.07021 - Ewing - IL - - 618 - CST - 62956 - -88.97394 - 37.29107 - Karnak - IL - - 618 - CST - 62319 - -90.75443 - 40.15108 - Camden - IL - - 217 - CST - 62207 - -90.12829 - 38.58734 - East Saint Louis - IL - - 618 - CST - 60474 - -88.28000 - 41.17000 - South Wilmington - IL - - 815 - CST - 62863 - -87.79111 - 38.41473 - Mount Carmel - IL - - 618 - CST - 62959 - -88.92940 - 37.72570 - Marion - IL - - 618 - CST - 61428 - -90.13981 - 40.95508 - Dahinda - IL - - 309 - CST - 62441 - -87.69226 - 39.42200 - Marshall - IL - - 217 - CST - 61790 - -89.01000 - 40.52000 - Normal - IL - - 309 - CST - 61346 - -89.77856 - 41.54088 - New Bedford - IL - - 815 - CST - 62618 - -90.42285 - 40.00436 - Beardstown - IL - - 217 - CST - 61272 - -90.98786 - 41.21526 - New Boston - IL - - 309 - CST - 61474 - -90.37978 - 40.72890 - Saint Augustine - IL - - 309 - CST - 60550 - -88.87520 - 41.76380 - Shabbona - IL - - 815 - CST - 62998 - -89.44076 - 37.51199 - Wolf Lake - IL - - 618 - CST - 60613 - -87.65749 - 41.95434 - Chicago - IL - - 312 - CST - 62414 - -88.80385 - 39.18352 - Beecher City - IL - - 618 - CST